NPI 1013053842

Gdr, INC

Organisation Community/Retail Pharmacy Tchula, MS

Practice location

Address: 112 Mercer Street, Tchula, MS 39169
Phone: (662) 235-4422
Fax: (662) 235-4301
Mailing address: PO Box 217, Tchula, MS 39169-0217

Authorised official

Name: Glenn Daniel Roberts
Title: President
Phone: (662) 235-4422

Registered specialties

Community/Retail Pharmacy Primary

Suppliers Taxonomy 3336C0003X Licence 01455 (MS)

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Registry record

NPI: 1013053842
Entity type: Organization
NPI issued: 29 Jan 2007
Record last updated: 22 Aug 2020

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.